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INGALLS HEALTH VENTURES
DSH140292 UChicago Medicine AdventHealth GlenOaks
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth GlenOaks
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140292
Entity Address
701 WINTHROP AVENUE
GLENDALE HEIGHTS, IL 60139-1405
Medicare Provider Number
140292
Participating Start Date
7/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
INGALLS HEALTH VENTURES
Pharmacy Address
1551 HUNTINGTON DR STE A
CALUMET CITY, IL 60409
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/5/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jared Brown, Chief Financial Officer
(630) 312-6003
Contract Pharmacy Representative
U of Chicago Medicine
Sandeep Parsad, Pharmacy Director
(773) 702-3584
Signed By Date
4/12/2023
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